NPI | 1104000769 |
---|---|
Former Name | STACY FYE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 3299) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
101YP2500X Counselor, Professional (Licence: MS 1407) | |
Enumeration Date | 2007-12-19 |
Last Update Date | 2024-05-06 |